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This report describes two patients with peripheral neuropathic pain (PNP): a 43-year-old man with upper leg PNP and a 75-year-old woman with post herpetic neuralgia of the perineum and vagina. Pain was inadequately managed in both patients for a long time. A patient-tailored approach, including a combination of systemic and topical compounds, required multiple adjustments for each patient before finally achieving adequate pain control. The first patient achieved pain control with a combination of systemically-administered drugs: dipyrone (1 g 3 times a day), pregabalin (300 mg twice a day), duloxetine (60 mg once daily in the morning), and dextromethorphan (60 mg 3 times/day), plus topical compounds (10% ketamine, 5% lidocaine, and 10% ketoprofen) in penetrating enhancing gel, and sublingual ketamine (10 mg) for breakthrough pain. The second patient achieved optimal pain control with dipyrone (500 mg three times per day), pregabalin (150 mg twice a day), dextromethorphan (60 mg three times per day), plus topical compounds (10% ketamine, 0.3% clonidine, 5% diclofenac) in a penetrating enhancing gel. Notably, the individualized approach described herein was made possible through collaboration between a public health pain specialist and a private sector compounding pharmacist, highlighting the importance of such infrequent but, highly desirable collaborations.

Background: The current medical treatment of neuropathic pain (NP) is inadequate with more than two thirds of patients having no suitable solution for their morbid disease and deteriorating quality of life. Currently, medications for the treatment of NP are mostly systemic (affecting the central nervous system) and are dose limited because of serious and debilitating adverse effects. Scientific evidence suggests that localized cutaneous NP can be treated effectively and safely by topical medications; however, only a few topical medications are indicated for NP. This lack of topica medications stems from the limited resources that have been dedicated to exploring the role of the peripheral nervous system in NP or to the development of peripherally active topical analgesics., Objectives: To explore the evidence supporting the role of topical medications and the role of an expert compounding pharmacist in compounding effective and safe topical preparations to treat NP., Methods: A narrative review., Results: Well-designed randomized control trials and increasing number of case reports have shown positive results regarding a few topical compounded medications for the treatment of various pathologies of NP. This review summarizes the relevant scientific data supporting the use of topical medication in treating certain types of NP., Discussion: This article discusses the role of topical medications in treating localized cutaneous NP and the role of the compounding pharmacists in applying this therapeutic approach (eg, the scientific considerations that the pharmacist should take into account).

The case report discussed in this article illustrates the painful endeavor of a patient who suffered from severe peripheral neuropathic pain and the to-and-from treatment adjustments that are needed before an optimal grade of pain control and an acceptable quality of life could be achieved. The next to optimal treatment was obtained by meticulously adjusting drugs and combining systemic drugs with topical ones. Compounding pharmacists play an important role in offering potent topical preparations that give an important analgesic added value to complex treatments.

Occasional clinical observations have shown extensive caries lesions in small children between 12 and 36 months of age, in some of which cases, while sugar intake history was negative, continuous use of teething jellies, lozenges or syrups was established. This prompted the hypothesis that such products were the source of the hidden fermentable sugars, and the sugar content of a number of products available on the Swiss market was therefore analyzed. Sucrose was determined enzymatically using the Boehringer sucrose/glucose UV-test. The content of other fermentable carbohydrates was checked by GLC. The use of such products should not be recommended for real or assumed pain related to the eruption of primary teeth. Among the eight products tested only one was found to be free of fermentable sugars. All other preparations contained 31-93% fermentable sugars, chiefly sucrose. Declaration of fermentable sugars in such products should be enforced by food and drug legislation.